The Pop Reporter®

– Events – Archives – Subscribe – Modify Profile – Headline Sharing Program – The Pop Reporter en Español (Spanish)

Volume 4, Number 6
9 February 2004

"The Pop Reporter" (R) Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs INFO Project Get news and research headlines delivered to your website, every day, customized to topics of interest to your webiste visitors. The Pop Reporter Headline Sharing Program is a free service of The INFO Project, with funding from USAID. Complete the form at our sign up page and let us know which news and research topics you want to display on your website. We will contact you to discuss the specific requirements for displaying The Pop Reporter headline box on your website. When you click on any link below, your Internet browser will access a Web site not connected to "The Pop Reporter." Information accessed through these links and contained in this issue of "The Pop Reporter" does not necessarily state or reflect the views of the INFO Project, Johns Hopkins University, or the US Agency for International Development. All links were verified at the date of mailing. Your computer and/or network configuration regarding Java script, cookies, and other security issues may not allow you to view certain Web sites. Consult your computer technician if you are having problems.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care (report)
(You need Adobe Acrobat Reader to access this document)
Related news article: Rich 'Failing' on Birth Control
Related resource material: Resource Page at AGI for "Adding It Up" Report
Related press release: New Report Documents Vast Benefits of Investing in Sexual and Reproductive Health Care
Gaps in sexual and reproductive health care account for nearly one-fifth of the worldwide burden of illness and premature death, and one-third of the illness and death among women of reproductive age. These gaps could be closed and millions of lives saved with highly cost-effective investments, according to this new report by The Alan Guttmacher Institute and the United Nations Population Fund.

Syphilis and HIV Prevalence among Commercial Sex Workers in Central Java, Indonesia: Risk-Taking Behavior and Attitudes that May Potentiate a Wider Epidemic (news article)
This cross-sectional study was conducted on 200 commercial sex workers (CSWs) from two brothel communities in Central Java, Indonesia, to determine the seroprevalence of syphilis and HIV and characterize associated knowledge, beliefs, and risk-taking behaviors. A questionnaire was administered and blood drawn for HIV and syphilis serologies. Focus groups with a total of 20 women were also conducted at both communities to supplement survey data. The mean CSW age was 27.3 years; mean number of clients seen per day was 2.27. The prevalence of syphilis and HIV were 7.5% and 0.5%, respectively. Thirty percent said they and their partners never used condoms during sex, and only 3% said they always used condoms. The most common client groups were truck drivers and sailors. The authors write that, while Central Java appears to remain in a pre-epidemic state, there is enormous potential for a significant increase in HIV and STD transmission.

Determinants of Pill Failure in Rural Bangladesh (research abstract)
The pill is the most popular family planning method in Bangladesh, yet the failure rate of this method in a typical rural area (Matlab) has been found to be very high. The study included 167 cases and 167 controls to determine the causes of pill failure. Results of the analysis of both quantitative and qualitative data suggested that the following were the risk factors for pill failure: no mobility of women, poor knowledge of women about the effectiveness and consequences of drop-out from pill use, weak confidence in the pill, a gap between the use of subsequence pill cycles, delay in starting the pill after menstruation for the first use, not taking any measures consistently for missing the pill, and not following the arrow sign given on the pill cycle.

The Determinants of Withdrawal Use in Turkey: A Husband's Imposition or a Woman's Choice? (research abstract)
This paper seeks to understand why Turkey has one of the highest rates of withdrawal (coitus interruptus) use in the world: in 1998 one in four Turkish couples relied on withdrawal. Researchers used the husbands' module of the 1998 Turkish Demographic and Health Survey to examine user characteristics and attitudes, as well as the determinants of withdrawal use among a representative sample of 1,950 currently married men in Turkey. Researchers found that measures of male authority had only partial predictive power after controlling for other variables. Although withdrawal use typically reflects husbands' preferences, it is widely practiced as it satisfies user requirements and simplifies womens' lives. The results of this study are discussed in a broader historical and cultural context and used to provide insight into how Turkey's family planning and reproductive health programs might be improved.

Two-year Performance of a Nestorone®-releasing Contraceptive Implant: A Three-center Study of 300 Women (research abstract)
A 2-year trial of a single Nestorone® (NES) rod implant was conducted at three Latin American centers, each enrolling 100 women. The authors studied the safety, effectiveness, and acceptability of this progestin-releasing contraceptive implant. The 2-year cumulative pregnancy rate was 1.7 per 100 with a Pearl index of 0.6 per 100 for the 2-year period. The 1-year and 2-year continuation rates were 80.5 and 66.7 per 100, respectively. Menstrual and medical disturbances were the principal reasons for discontinuation, followed by planned pregnancy. Headache and weight gain frequently led to discontinuation. The NES implant had little important effect on most clinical chemistry and lipid parameters.

Determinants of Contraceptive Method Choice in Rural Tanzania between 1991 and 1999 (PubMed abstract)
Researchers used four pooled Demographic and Health Survey data sets to examine the determinants of contraceptive method choice in rural Tanzania from 1991 to 1999. The individual data were linked to facility surveys conducted in the same communities so that the impact of Tanzania's family planning program could be examined. The focus of the study is an examination of the effect on method choice of the three major components of Tanzania's family planning program: logistical support, trained providers, and communications programs. The statistical methods employed correct for the potential endogeneity of family planning message recall. Simulations are used to quantify the impact of the important policy variables. All three components of the program are shown to have had an impact on modern method choice.

The Quality of Family Planning Programs: Concepts, Measurements, Interventions, and Effects (PubMed abstract)
This study reviews the major research and interventions concerning readiness and quality of care in family planning programs. It has three aims: to identify and describe the principal methodological research including conceptual frameworks, perspectives, and tools for measuring and improving quality; to describe the results from various intervention studies; and to assess what is known about the effect of such interventions. The review suggests that interventions that improve client-provider interactions show the greatest promise. Good quality of care results in such positive outcomes as clients' satisfaction, increased knowledge, and more effective and longer use of contraceptives. The authors conclude that rigorously documented evidence of the effects of interventions is sorely needed. The review indicates areas requiring additional research.

Cervical Changes Associated with Progestagen-only Contraceptives: A Team Approach (research abstract)
A total of 325 current users of contraceptive methods for more than 3 years were divided into two groups. Group A included 200 patients using progestagen-only contraceptives. Group B comprised 125 patients wearing IUDs. Cytologic examinations revealed positive cases of low- and high-grade squamous intraepithelial lesions in 38 (19%) and 22 (17.6%) in the study and control groups, respectively, without any statistically significant difference. There were no statistically significant differences in both groups regarding the frequency of positive cases whether using Ayre's spatula or the endocervical brush. The authors conclude that prolonged use of progestagen-only contraceptives is not associated with increased risk of abnormal cytologic findings.

Human Synthetic Peptide Vaccine for Contraception Targeting Sperm (research abstract)
In this study, researchers identify a novel synthetic peptide that appears to be an attractive candidate for contraceptive vaccine development.

Effect of Hormonal Emergency Contraception on Bleeding Patterns (research abstract)
The objective of this study was to determine if there was any correlation between bleeding pattern following the use of emergency contraception and treatment outcome. Using data from a large multicenter efficacy trial, researchers examined bleeding patterns post-emergency contraception. The earlier in the cycle the pills were taken, the more likely the next bleed was to be early and the less likely it was to be on time. There was no observable difference in spotting rates between women who got pregnant and those who did not. The occurrence of spotting did not influence whether the next period was lighter or heavier.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

FDA and Johnson and Johnson Warn Public About Counterfeit Contraceptive Patches Sold Through Foreign Internet Site (press release)
Related news article: FDA: Fake birth control patches shipped
An overseas Internet site is shipping counterfeit versions of a popular Johnson & Johnson birth control patch, versions that won't provide any protection against pregnancy, federal health officials warn. The Food and Drug Administration urged consumers not to use Ortho Evra patches, or any other drugs, ordered from the website www.rxpharmacy.ws, which apparently is operated by American Style Products of New Delhi, India. The site also sells other products that purport to be versions of FDA-approved drugs. FDA is investigating these other products as well, and urges consumers to treat any drugs purchased from this firm as being suspect. None of the products should be considered safe or effective.

Abstinence Key to Avoiding Sex Disease (news article)
The best ways to protect against a widespread sexual disease are to abstain from sexual relations or stay in a monogamous relationship with an uninfected partner, according to the CDC in a report that downplays condom use. "The surest way to eliminate risk for future genital [human papillomavirus] infections is to refrain from any genital contact with another individual," the CDC says in its report to Congress released last week.

Uganda: Female Condom Failed - Minister (news article)
Condoms for women failed to catch on because they were not compatible with our social norms, a government minister has said. "Women condoms were not adopted because of the social norms," Mike Mukula said last week while addressing journalists with the Uganda Journalists Association at Old Kampala. "It is like bringing homosexuality here or eating pilipili [red pepper]. Their adaptability was the problem." Mukula is the minister of state for health.

Brazil Hands Out Condoms for Carnival Safe Sex (news article)
Brazil on Monday began handing out a record 10 million contraceptives to stop the spread of AIDS during Carnival when casual sex rises. With the pre-Lenten festival less than 2 weeks away, the "nothing gets past a condom" campaign focuses on the 14 million Brazilians, or 15% of those sexually active, who don't believe condoms prevent the spread of the HIV/AIDS virus.

South Africa: Condom Hand-outs on Rise (news article)
The government of South Africa gave out 270 million male condoms last year, which is an 80% increase from 1997 when 150 million were distributed, the department of health said today. The department announced the figures at the launch of its Sexually Transmitted Infections/Condom Week, which runs from February 9 to 14. The campaign's theme is "If you love me, respect me and protect me", the department said in a statement.

Israeli Team Develops New Method of In Vitro Fertilisation (news article)
An Israeli team of male infertility experts have developed a new step in the reproductive medical technique of intracytoplasmic sperm injection that they say improves the method’s pregnancy rate and the "take home baby" rate.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Pakistan's Maternal and Child Health Policy: Analysis, Lessons and the Way Forward (research abstract)
This analysis of Pakistan's maternal and child health and family planning policy covers the period 1990–2002 and focuses on macroeconomic influences, priority programs and gaps, adequacy of resources, equity and organizational aspects, and the process of policy formulation.

Malawi Gets AIDS Policy (news article)
Malawi's President Bakili Muluzi will on Tuesday launch the country's first-ever policy on HIV/Aids amid claims by health officials that the alarming infection rates in the southern African nation have stabilised over the years. Biswick Mwale, head of Malawi's national AIDS commission, said the policy, on which work started in 2000, will try to provide a legal and administrative framework to combat the epidemic, which infects 14.4% of the country's 11 million people.

Africa: Conference Delegates in Ethiopia Call for End to FGM (news article)
African governments faced renewed demands on Friday to introduce and enforce tough laws to stamp out FGM and protect the women of their countries. Leading health and human rights experts on the continent called for legislation to end the practice to which 2 million African women and girls in 28 countries are subjected every year. Only 16 African countries, including Ethiopia, have adopted laws to protect women and girls from the ancient custom, which is also blamed for spreading HIV/AIDS.

Ghana: Jailing Shows Difficulties of Halting Mutilation (feature article)
Related news article: Female Genital Mutilation in Ghana
The case of a 70-year-old Ghanaian woman jailed for circumcising seven girls highlights the difficulty of enforcing a ban on the traditional practice still performed in 28 African countries. Abampoaka Mbawini was convicted on January 23 and jailed for five years after pleading guilty to circumcising the girls in the northern-most part of the west African state. Judge Jacob Boon acknowledged that the sentence may have been harsh but said it was aimed to serve as a deterrent to other practitioners and a warning that the law would not be lenient any longer. But lawyer Frank Owusu said the judge did not go far enough. "To make its eradication more effective, that is to minimise its occurrence, the parents of the girls who were sent to the old woman should have also been charged. The woman did not go and drag them to her house for the deed." Despite laws in place in Ghana since 1994 that mandate fines and jail for anyone caught performing an excision, in which the clitoris and labia are removed, about 75% of girls in the rural north and west are still circumcised to mark their passage into adulthood. Ghana, like most of the 28 African states where female genital mutilation remains common, considers the practice to enhance a girl's feminine side, which in traditional communities is often synonymous with docility and obedience.

HIV/AIDS RESEARCH

Second-generation HIV Surveillance: Better Data for Decision-making (research article)
(You need Adobe Acrobat Reader to access this document)
This paper emphasizes improvements in existing surveillance methodologies and discusses in detail crucial issues such as the validity of HIV prevalence data measured in pregnant women and linking HIV surveillance and behavioural data collection. In addition, a strategic partnership between second-generation surveillance and AIDS program evaluation is proposed that stresses the complementary roles of these data collection activities in determining the effectiveness of prevention and care programs and explaining the epidemiological trend data collected by sentinel serosurveillance systems.

Black Caribbean Adults with HIV in England, Wales, and Northern Ireland: An Emerging Epidemic? (research article)
In this paper the authors review the epidemiological data describing HIV/AIDS in black Caribbean adults in England, Wales, and Northern Ireland, describe the evolution of the HIV epidemic in this ethnic group in the United Kingdom, and examine the inter-relations between epidemics in the Caribbean and the United Kingdom.

Predicting the Impact of Antiretrovirals in Resource-Poor Settings: Preventing HIV Infections whilst Controlling Drug Resistance (research abstract)
The authors use mathematical models to predict the potential impact that low to moderate usage rates of antiretroviral (ARV) therapy might have in developing countries. They also review the current state of HIV/AIDS treatment programs in resource-poor settings and identify the essential elements of a successful treatment project, noting that one key element is integration with a strong prevention program. They apply program experience from Haiti and Brazil and the insights gleaned from their modeling to address the emerging debate regarding the increased availability of ARVs in developing countries. Finally, they show how mathematical models can be used as tools for designing robust health policies for implementing ARVs in developing countries.

HIV/AIDS NEWS

US: 200 Atlanta Gays to Test Whether Pill Stops HIV (news article)
About 200 gay men in Atlanta will be among the first 3,000 people in the world to test a promising but controversial new AIDS strategy: a pill to prevent HIV infection. Three studies to begin this spring, including one funded by the CDC, will look at whether the drug tenofovir can stop HIV from causing infection. The drug, also known as Viread, is now used to treat people who have the virus that causes AIDS.

Unsafe Injections Rejected as Major Source of HIV Infection in Africa (news article)
A recent theory proposing that unsafe injections are a major cause of HIV-1 infection in sub-Saharan Africa is rejected by authors of an article in this week's issue of The Lancet.

Zambia to Conduct HIV/AIDS Vaccine Trials (news article)
Zambia is preparing to conduct HIV/AIDS vaccine trials, according to the National Aids Council (NAC) director-general Dr. Rosemary Musonda. In an interview on Friday, Dr. Musonda said the technical working group would conduct the vaccine trials in conjunction with NAC. She said the Tropical Disease Research Centre in Ndola is also obtaining baseline information in collaboration with Duke University in the United States before the trials could proceed.

Botswana: AIDS Survey Results Encouraging (news article)
The results of a survey on how well pregnant women understand interventions for prevention of mother-to-child transmission are encouraging: 94% of pregnant women believe that all pregnant women should be tested, which indicates that pregnant women are ready for "routine" HIV tests as mandated by President Festus Mogae.

Permissive African Sexual Traditions Spread AIDS (feature article)
Men in the arid, remote Kenyan town of Isiolo have long had sex with young virgins to purge themselves of afflictions or curses. Now the age-old custom practiced by the nomadic peoples of Kenya's northeastern province is increasingly being used as a cure for HIV/AIDS. A man named Nassir hesitantly admits he slept with a nine-year-old girl because the clan elders in Isiolo, 200 km (124.3 miles) northeast of Kenyan capital Nairobi, said it would rid him of frequent bouts of illness brought on by HIV. "I was given a girl of nine years to sleep with for a week," Nassir said. "I took pity on her but if it wasn't for this disease I wouldn't have slept with her...I had to do what the elders had said." Isiolo's pastoralist community practices a mix of Muslim and traditional African beliefs. Illiteracy is high and AIDS is shrouded in stigma and superstition.

Bangladesh: Waking Up to the Threat of AIDS (editorial)
This editorial suggests that ad campaigns designed to spread awareness about preventive methods of HIV should be increased. The message needs to be imprinted seriously and extensively in the minds of the greatest number of people that AIDS is a preventable disease. The editorial also calls for the regular monitoring of the movements of vulnerable groups like prostitutes and people who travel from foreign countries.

A New Kind of War: PSI Arms African Militaries Against AIDS (resource material)
(You need Adobe Acrobat Reader to access this document)
Related press release: PSI Arms Militaries Against AIDS
HIV prevalence rates are typically higher amongst the military than the general populace, a growing trend which threatens the security and stability of many developing countries and has attracted the attention of the United Nations Security Council. The military and uniformed services are a group at high risk for contracting and transmitting HIV, and this new profile "A New Kind of War: PSI Arms African Militaries Against AIDS," from Population Services International outlines its HIV prevention work with the military. From training soldiers as peer educators to launching voluntary counseling and testing centers on military bases, PSI is arming the military with the weapons to fight perhaps their most perilous foe: HIV/AIDS.

Manto Punts 'Eccentric' AIDS Plan Once More (news article)
South African Health Minister Manto Tshabalala-Msimang defended an eccentric diet of garlic, lemon, onion, and olive oil for HIV and AIDS sufferers on Monday, saying it was important not to ridicule traditional medicine. Tshabalala-Msimang is a qualified medical doctor and said her ministry was working with South Africa's Medical Research Council to research traditional medicines.

MATERNAL AND CHILD HEALTH RESEARCH

Prenatal Care in the Paso del Norte Border Region (PubMed abstract)
This study investigated the impact of a Medicaid-managed care system on access to prenatal care. Postpartum interviews and medical chart abstractions were conducted among 493 Hispanic women who reside on the El Paso Texas/Juarez Mexico border (the Paso del Norte region). The factors reported by these women as barriers to timely entry and sustaining enrollment in prenatal care were related to the availability of social support networks and affiliation with the Mexican/Hispanic culture (acculturation). Having Medicaid-managed care or other insurance was associated with receiving more adequate levels of prenatal care. Women who crossed the border to seek perinatal services were more likely to have infants who received higher levels of neonatal care.

Gender Differences in Child Survival in Contemporary Rural China: A County Study (research abstract)
Using data from a survey of deaths of children less than 5 years old conducted in 1997 in a county in Shaanxi Province, China, this paper examines gender differences in child survival in contemporary rural China.

Outcome of Subsequent Pregnancy Three Years after Previous Operative Delivery in the Second Stage of Labour: Cohort Study (research article)
Related news article: Instrumental delivery makes future vaginal delivery more likely
British researchers conducted this study to survey the reproductive outcome and the mode of delivery in subsequent pregnancies after instrumental vaginal delivery in theatre or caesarean section at full dilatation. Participants were a cohort of 393 women with term, singleton, cephalic pregnancies who needed operative delivery in theatre during the second stage of labor. Women were more likely to aim for vaginal delivery and more likely to have a vaginal delivery if they had had a previous instrumental vaginal delivery rather than a caesarean section. There was a high rate of vaginal delivery after caesarean section among women who attempted vaginal delivery 17/18 (94%). In both groups, fear of childbirth was a frequently reported reason for avoiding a further pregnancy (51% after instrumental vaginal delivery, 42% after caesarean section). The authors write that instrumental vaginal delivery offers advantages over caesarean section for future delivery outcomes.

Circulating Angiogenic Factors and the Risk of Preeclampsia (research abstract)
Related news article: Test May Warn of Serious Pregnancy Complication
A test that looks for two proteins in the blood of pregnant women may indicate the onset of preeclampsia, a serious complication that affects as many as one in 20 pregnancies in the United States, researchers announced last week.

Outcomes of Training Traditional Birth Attendants in Rural Honduras: Comparison with A Control Group (research article)
(You need Adobe Acrobat Reader to access this document)
This paper compares obstetrical knowledge, referral practice, and integration into the public health system among trained and untrained traditional birth attendants (TBAs) in rural Honduras. Eighteen practicing TBAs in rural Honduras completed traditional lay midwife training in 2000, and 26 months later, a randomly selected six of these and six untrained "control" TBAs from a nearby village were interviewed to assess maternal mortality process indicators, including obstetrical knowledge, referral practices, and monthly training meeting attendance. At 26 months post- training, the trained TBAs demonstrated uneven but persisting achievement of curricular learning goals relating to identification of high-risk pregnancies and management of obstetrical emergencies, increased and appropriate referrals to the government health system, and increased meeting attendance compared with the control group of TBAs. The authors conclude that these outcomes support this model of training TBAs as a component of programs to decrease maternal mortality in geographically isolated and impoverished regions.

Randomised Controlled Trial of Labouring in Water Compared with Standard of Augmentation for Management of Dystocia in First Stage of Labour (research article)
Related news article: Water Delivery Helps Labour Progress
In this randomised controlled trial, researchers evaluate the impact of laboring in water during the first stage of labor on rates of epidural analgesia and operative delivery in nulliparous women with dystocia. Participants included 99 nulliparous women with dystocia at low risk of complications. Women randomised to immersion in water had a lower rate of epidural analgesia than women allocated to augmentation (47% vs. 66%). They showed no difference in rates of operative delivery, but significantly fewer received augmentation (71% vs. 96%) or any form of obstetric intervention (80% vs. 98%). The authors conclude that laboring in water under midwifery care may be an option for slow progress in labor, reducing the need for obstetric intervention, and offering an alternative pain management strategy.

MATERNAL AND CHILD HEALTH NEWS

Traditional Rulers in Northern Nigeria Call for Halt to Polio Vaccination (news article)
The controversy over the administration of poliomyelitis vaccines in northern Nigeria has taken a new turn as traditional rulers from the region have asked the Nigerian government to stop administering the vaccine because of fears that it is contaminated.

MEN'S HEALTH RESEARCH

Post-meiotic Gene Products as Targets for Male Contraception (research abstract)
The authors discuss the possibility of targeting a contraceptive agent to the process of post-meiotic spermiogenesis.

POPULATION NEWS

Do Not Trust Too Much in Population Statistics, Indon President Says (news article)
Indonesian President Megawati Soekarnoputri has warned the people against trusting too much in the statistics on the country`s population. "Let us avoid trusting too much in the statistics on our country`s population," Megawati said when opening the national meeting of the National Family Planning Board at the state palace here Monday. She said people are elated when the population figure is low, but scramble to reduce the figure when it rises.

WOMEN'S HEALTH RESEARCH

Women’s Health and Life Events Study in Rural Ethiopia (research article)
(You need Adobe Acrobat Reader to access this document)
This report presents major findings from a field research conducted in Meskan and Mareko district in south central Ethiopia. The research was conducted by a multidisciplinary team with extensive field research experiences in the areas of domestic violence, reproductive health, mental health and epidemiology. More than 3,000 women were systematically selected for the study both from urban and rural areas. Data were collected using standard questionnaires for domestic violence and mental health. The results show that 59% of women suffered from sexual violence, and 49% from physical violence by a partner, at some point in their lives. During the 12 months prior to the survey, 44% of women reported sexual violence and 29% suffered partner violence. Major lifetime mental health problems include depressive episode, Somatoform disorder and recurrent depressive episodes diagnosed in 6%, 3%, and 2% of the women, respectively. Women who suffered from domestic violence also reported more symptoms of mental distress, although the degree of association is not fully explored in this report. The majority of violence reported by women was inflected by intimate partners. The low status of women in the society, a lack of general awareness about human/women’s rights, and weakness in the law enforcement system are some of the reasons for the wide spread violence. The authors write that, to end violence against women and promote a healthy and secure life for women, coordinated efforts by all concerned are needed. Efforts must also focus in improving the conditions of the family as a whole.

The Potential Epidemiological Impact of a Genital Herpes Vaccine for Women (research abstract)
Results from this study suggest that a herpes vaccine should be used universally and that a vaccine that only protects HSV-1-/2-women can paradoxically have a significant epidemiological impact, the scale of which depends upon changes in patterns of viral shedding.

The Effect of Oral Contraceptives and Estrogen Replacement Therapy on the Risk of Rheumatoid Arthritis: A Population Based Study (research abstract)
Researchers examined whether exposure to either oral contraceptives (OC) or postmenopausal estrogen replacement therapy (ERT) is associated with the development of rheumatoid arthritis (RA) in women. Case patients, including all female residents of Rochester, Minnesota, more than 18 years of age, who first fulfilled 1987 American College of Rheumatology criteria for RA between 1955 and 1994 (n=445), were compared with age matched female controls from the community. The researchers observed an inverse association between ever-use of OC and the risk of RA, which persisted after adjusting for potential confounders in multivariate analyses. Earlier calendar-year of first exposure to OC was associated with lower OR for RA. They found no evidence of a significant association of ERT with RA risk.

The Impact of Rape on Women's Sexual Health Risk Behaviors (research abstract)
This study used cluster analysis to identify three patterns of sexual health risk behaviors in a sample of adult rape survivors.

WOMEN'S HEALTH NEWS

Fistula Makes Social Outcasts of Child Brides (feature article)
This feature article relates the misery and isolation that African women endure when they suffer obstetric fistula.

Niger: Legal Ban on Female Circumcision Widely Ignored (news article)
Niger’s Minister for Social Development and Women's Affairs called on Friday for a government crackdown of Female Genital Mutilation (FGM). The practice was made illegal in this poor West African country 3 years ago, but it remains widespread and no one has ever been prosecuted for performing the crude operation.

YOUTH HEALTH RESEARCH

Sexual Behaviour of Young People in International Tourist Resorts (research abstract)
Related news article: Casual Holiday Encounters Threaten UK's Sexual Health
Casual sex between young people while on holiday is leading to a big rise in the spread of sexually transmitted diseases, according to a new repor by British researchers. The report's authors surveyed 1,500 travellers between the ages of 16 and 35 at Ibiza airport, as they were preparing to return home to the UK and found that the proportion of visitors having unprotected sex increased over the 3 survey years. The authors said this poses an increasing threat to the sexual health of UK residents.

Adolescents' Views on Decision-making Regarding Risky Sexual Behaviour (research abstract)
This study explored adolescents' views regarding risky sexual behavior. A sample of adolescents between 13 and 19 years of age particicpated in 24 focus group discussions, six in each of the four regions of Swaziland (Manzini, Hhohho, Lubombo and Shiselweni). Researchers found four major themes to be important factors in decision-making for risky sexual behaviors: sexual behavior, age at first intercourse, peer pressure, and trust in the relationship.

The Sexual Health of Pupils in Years 4 to 6 of Primary Schools in Rural Tanzania (research abstract)
The aim was to describe the sexual health of pupils in years 4 to 6 of 121 rural primary schools in north western Tanzania, before the implementation of an innovative sexual health intervention in 58 of the schools. The study population comprised pupils registered in years 4 to 6 of 121 primary schools in 20 rural communities in 1998. Basic demographic information was collected from all pupils. A total of 9,283 pupils were enrolled and provided demographic information and a urine sample. Male pupils were significantly older than females (mean age 15.5 years v 14.8 years), but all other demographic characteristics were similar between the sexes. Of the pupils, 14 (0.2%) (four male and 10 female) were HIV positive, 83 (0.9%) were positive for Chlamydia trachomatis, and 12 (0.1%) for Neisseria gonorrhoeae. Pregnancy tests were positive for 32 female pupils (0.8%). Sexual experience was reported by one fifth of primary school girls, and by almost half of boys. Only 45/114 (39%) girls with biological markers of sexual activity reported having had sex.

Adolescents in Vietnam: Looking Beyond Reproductive Health (PubMed abstract)
Research conducted to date on Vietnamese adolescents has focused on unprotected and unsanctioned sexual activity and its health consequences, specifically abortion and STDs, especially HIV. In this paper, the authors question whether this concern is warranted.

Vulvovaginal Candida in a Young Sexually Active Population: Prevalence and Association with Oro-genital Sex and Frequent Pain at Intercourse (research abstract)
Researchers studied the prevalence of vulvovaginal candida among sexually active adolescents to determine past and present symptoms, including pain at intercourse and potential behavioural risk factors associated with vulvovaginal candidiasis. At an adolescent centre, 219 sexually active women who underwent genital examination, also completed a questionnaire on a history of genital symptoms and infections, sexual and hygiene habits, and the use of contraceptives. Vaginal samples were also analysed. Candida culture was positive in 42% of the women and only 15% were asymptomatic. A history of recurrent candidiasis was given by 22%. Frequent pain at intercourse was reported by 24% and frequent oro-genital sex by 42% of the women. Frequent pain at intercourse was significantly associated with both the growth of candida and a history of recurrent candidiasis. Oro-genital sex was an independent risk factor for the growth of candida.

Vaginal Yeast Colonisation, Prevalence of Vaginitis, and Associated Local Immunity in Adolescents (research abstract)
Researchers evaluated point prevalence vaginal yeast colonisation and symptomatic vaginitis in middle adolescents to identify relation of these yeast conditions with reproductive hormones, sexual activity, sexual behaviours, and associated local immunity. Middle adolescent females (n=153) were evaluated for STIs, asymptomatic yeast colonisation, and symptomatic vulvovaginal candidiasis (VVC) by standard criteria. Rates of point prevalence asymptomatic yeast colonisation (22%) were similar to adults and similarly dominated by Candida albicans, but with uncharacteristically high vaginal yeast burden. In contrast with the high rate of STIs (18%), incidence of symptomatic VVC was low (under 2%).

Expanding the Flexibility of Normative Patterns In Youth Sexuality and Prevention Programs (review article)
(You need Adobe Acrobat Reader to access this document)
This article reviews normative ways of presenting sexual health in intervention programs for the sex education and health care of young people in Latin America. These programs usually consider adolescence and youth as naturalizing categories and can be described as strongly preventionist. Based on their activities in Brazil, ongoing research and training of health professionals and activists, and inspiration from recent debates about youth sexuality and reproductive health in Latin America, the authors present and analyze face to face scenes from the field. The authors conclude that sexual health and adolescence should be strongly contextualized categories; that adolescent identities should be understood as "ipse identities" (Ricoeur, 1991), or as reflexive identities constructed continuously in relationship with otherness; and that there is a promising relationship between sexuality and human rights.

YOUTH HEALTH NEWS

Latin America's Adolescents Demand More Health Information, Study Shows (press release)
A new study by the Pan American Health Organization reports that adolescents trust the news they read and hear about health issues but at the same time are eager for even more information. The study surveyed 533 adolescents aged 12 to 19 in 11 Latin American nations. Respondents were asked about the role of the media in their daily lives. The study used focus groups made up of adolescents from middle-income and low-income urban families. Participants were asked about their experiences and opinions about the "old" media (print, radio and television) and the "new media" (videogames, cell phones and the Internet). The survey found a significant media presence, especially radio and television, in the daily lives of those interviewed. It also found that print media are not a consistent source of information for younger adolescents.

UK: Warning Over Clingfilm 'Condoms' (news article)
Cash-strapped teenagers are using clingfilm and crisp packets as condoms because they cannot afford the real thing, say experts.

BOOKS/BOOK REVIEWS

Indigenous Women’s Health Book, Within the Sacred Circle (book)
"Indigenous Women’s Health Book, Within the Sacred Circle" provides guidance in both Western and Indigenous health approaches to specifically address Native American women’s health needs. Topics covered range from traditional midwifery, pregnancy, the politics of reproductive health, contraception, domestic violence, barriers to Indigenous women’s healthcare, health effects of environmental contamination, traditional herbs and remedies, Native American nutrition and weight loss, smoking, alcohol, drug abuse, and much more. Written by a group of compassionate Indigenous women, activists, health experts, and healthcare providers, this pioneering book discusses both physical and mental health issues from a variety of perspectives.

SPECIAL REPORTS/PROFILES/RESOURCES

"35% of India's Population is Under 15" (interview)
In this interview, Tim Dyson, the Professor of Population Studies at the Development Studies Institute at the London School of Economics and the author of four books on India's population, elaborates on the findings in his latest book "Twenty-first Century India: Population, Economy, Human Development, and the Environment."

Problems and comments can be addressed to rjacoby@jhuccp.org. Archives available at http://www.infoforhealth.org/popreporter/. Subscribe at http://prds.infoforhealth.org/signup.php. Modify your account at http://prds.infoforhealth.org/modify.php. Have an item to contribute for consideration in The Pop Reporter? E-mail the URL and description to rjacoby@jhuccp.org. Forward this message to a friend who could benefit from INFO project activities! Sincerely, Robert Jacoby, rjacoby@jhuccp.org Editor, The Pop Reporter Johns Hopkins Center for Communication Programs

Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 4, Number 6 9 February 2004